CORNWALL & ISLES OF SCILLY ALCOHOL NEEDS ASSESSMENT 2016/17 Version 1.0 FINAL May 2017 Needs Assessment prepared by: Cornwall Council, Amethyst Alex Arthur Strategic Analyst Community Safety Intelligence Team Cornwall Council, Amethyst James Butler Strategic Analyst Community Safety Intelligence Team Cornwall Council, Amethyst Strategic Intelligence and Erika Sorensen Community Safety Performance Manager Intelligence Team Cornwall & Isles of Scilly Primary Care Development Angela Andrews Drug and Alcohol Action Manager Team Cornwall & Isles of Scilly Marion Barton Social Inclusion Officer Drug and Alcohol Action Team Cornwall & Isles of Scilly Jez Bayes Alcohol Strategy Manager Drug and Alcohol Action Team Cornwall & Isles of Scilly Kim Hager Joint Commissioning Manager Drug and Alcohol Action Team Cornwall & Isles of Scilly Drug-related Deaths Co- Sid Willett Drug and Alcohol Action ordinator Team Cornwall and Isles of Scilly Alcohol Needs Assessment 2016/17 2 OFFICIAL Contents Introduction 5 Section 1: Key messages and priorities 8 Our 8 themes 8 Commissioning priorities 18 Overview of Recommendations for Commissioners 20 Section 2: Setting the scene 26 Section 3: Our services and what people say 40 What did we achieve in 2015/16? 40 What our people say 43 Section 4: Examining the impacts of alcohol 48 National trends and evidence 49 Measuring the impacts on health 60 Alcohol Consumption and Risk Levels 62 Hospital admissions 65 Frequent Attenders 70 Alcohol and Suicide in Cornwall 76 Early Intervention 83 Identification and Brief Advice 84 Messaging and Communication 92 Mapping the treatment system 96 Why invest in treatment? 98 ‘Map and gap’ of existing services 100 Getting people into treatment 102 Tier 4 110 Mental health 112 Families 121 The impacts of parental substance use 122 Together for Families Programme 124 Transitions and young adults in treatment 135 Social Impact 138 Homelessness and housing need 140 Gypsy, travelling and migrant worker communities 151 Worklessness 154 Alcohol, crime and disorder 162 Alcohol-related crime 164 Anti-Social Behaviour 169 Road Traffic Collisions and Drink Driving 171 Reoffending 178 The Police and Crime Plan 185 Licensing and Retail 193 Health as a Licensing Objective (HaLO) 194 Local Alcohol Action Area Phase 2 198 Appendices 202 Cornwall and Isles of Scilly Alcohol Needs Assessment 2016/17 3 OFFICIAL Page intentionally left blank Cornwall and Isles of Scilly Alcohol Needs Assessment 2016/17 4 OFFICIAL Introduction Reducing the harms of alcohol has been a priority in Cornwall for many years. Our first Alcohol Harm Reduction Strategy was published in 2006. Our current alcohol strategy “Taking Responsibility for Alcohol1” draws on evidence compiled for the Alcohol Needs Assessment and has three overarching objectives: 1. Enable people to make informed choices about alcohol 2. Improve services to reduce the harm associated with alcohol 3. Partnerships to reduce alcohol’s negative impact on communities Cornwall Council and Cornwall’s Community Safety Partnership, Safer Cornwall, are responsible for reducing the harm related to drugs and alcohol locally. The statutory framework regulating Community Safety Partnerships (CSPs) requires partnerships to analyse and assess on an annual basis: Levels and patterns of crime, disorder, substance misuse and reoffending in both adults and young people; Changes in these areas since the last strategic assessment and why; The extent to which the previous year’s partnership plan was implemented. It is important therefore to review local needs and evidence for drug and alcohol provision and assess the impacts upon individuals, families and local communities. This information is used to inform the commissioning of a range of services and system improvements that seek to make a positive impact. The majority of the drug and alcohol services currently commissioned have contracts in place until March 2018. The Drug and Alcohol Action Team (DAAT) intends to undertake a procurement process to re-commission services for a revised system to be in place from April 2018 onwards. This needs assessment is a key part of that process. Drawing on a wide range of data sources (including self-reports, research and service level data) the needs assessment provides a series of recommendations for consideration (Commissioning Priorities). How Cornwall chooses to respond to these recommendations will be detailed within the Commissioning Strategy. Joint Strategic Needs Assessment support pack 2017/18: commissioning and good practice prompts Reducing the harms of alcohol is also a priority area of health and wellbeing improvement2 in the Sustainability and Transformation Plan. Alcohol consumption 1 Available to view and download from the alcohol pages of the Safer Cornwall website 2 The online resource library of assessments and focus papers for the Joint Strategic Needs Assessment includes the Alcohol Needs Assessment Cornwall and Isles of Scilly Alcohol Needs Assessment 2016/17 5 OFFICIAL is identified as one of five lifestyle behaviours (smoking, alcohol, physical inactivity, diet and social isolation) that contribute to the high prevalence of five diseases which cause 75% of premature death and disability. The national guidance from Public Health England for the needs assessments to support 2017/18 commissioning for drugs, alcohol and young people’s services is comprehensive and challenging. The DAAT Needs Assessment Expert Group has stretched to incorporate these new areas into its needs assessment each year. As before, we have rated ourselves against the national checklist, which has assisted us in mapping what is working well, what needs to improve and gaps for future development. The recommendations are wide ranging and indicate where we require the assistance of partners as well as commissioned services. Our self-assessment against the checklist for 2017/18 is available as part of the separate supporting documentation set for this needs assessment. What is needs assessment? Needs assessment is the cornerstone of evidence-informed commissioning. NICE (National Institute of Clinical Effectiveness) defines health needs assessment as a ‘systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities’3. It is based on: Understanding the needs of the relevant population from reliable data sources, local intelligence and stakeholder feedback; Systematic and comprehensive analysis of legislation, national policy and guidance; Understanding what types of interventions work, based on analysis of impact of local services, research and best practice. It is: A way of estimating the nature and extent of the needs of a population so services can be planned accordingly; A tool for decision making; To help focus effort and resources where they are needed most. A robust needs analysis provides commissioners with the range of information required to feed into and inform planning and prioritisation. 3 NICE guidance on Health Needs Assessment – www.nice.org.uk Cornwall and Isles of Scilly Alcohol Needs Assessment 2016/17 6 OFFICIAL Aims and objectives The purpose of needs assessment is to examine, as systematically as possible, what the relative needs and harms are within different groups and settings, and make evidence-based and ethical decisions on how needs might be most effectively met within available resources. Through undertaking a rigorous needs assessment, we aim to continue to ensure that systems and services are recovery focused, provide value for money and meet the needs of local communities. An effective needs assessment for drug interventions, treatment, support, recovery and reintegration involves a process of identification of: What works well, and for whom in the current system, and what the unmet needs are across the system Where there are gaps for clients in the wider reintegration and treatment system Where the system is failing to engage and / or retain people Who the hidden populations are and their risk profiles What are the enablers and blocks to treatment, reintegration and recovery pathways What is the relationship between treatment engagement and harm profiles? This provides a shared understanding of the local need for services, which then informs treatment planning and resource allocation, enabling residents to have their needs met more effectively, and ultimately benefiting the communities in which they live. Such an assessment will need to take full account of the gender, ethnicity and other diverse needs of the target population and any unmet needs from this perspective. The assessment also needs to be undertaken in accordance with the requirements of national guidance on undertaking equality impact assessments. Finding your way around Section 1 Key Messages and Priorities contains a summary of the key findings across the 8 themes of the Alcohol Strategy, gaps and priorities for improvement identified through mapping services against the relevant NICE guidance and other recommendations for commissioners, drawn from the evidence presented within each section of the Needs Assessment; Section 2 Setting the Scene describes the relevant national and local strategic contexts and provides a brief description of Cornwall in key statistics; Section 3 Our services and what people say provides a summary of new initiatives and service development, and presents the results of our consultation with service users, providers and key stakeholders;